ADHD

Attention-deficit/hyperactivity disorder (ADHD)

● ADHD is a lifelong brain disorder that makes it hard for a person to pay attention.
● (ADHD) is a brain disorder that affects how you pay attention, sit still, and control your behavior.

Risk and Prognostic Factors

Temperamental :ADHD is associated with reduced behavioral inhibition, effortful con-

trol, or constraint; negative emotionality; and/or elevated novelty seeking. These traits
may predispose some children to ADHD but are not specific to the disorder.

Environmental:Very low birth weight (less than 1,500 grams) conveys a two- to three-
fold risk for ADHD, but most children with low birth weight do not develop ADHD. Although ADHD is
correlated with smoking during pregnancy, some of this association
reflects common genetic risk.
A minority of cases may be related to reactions to aspects of diet. There may be a history of child abuse,
neglect, multiple foster placements, neurotoxin exposure (e.g., lead), infections (e.g., encephalitis), or
alcohol exposure in utero. Exposure to environmental toxicants has been correlated with subsequent
ADHD.

Genetic and physiological: ADHD is elevated in the first-degree biological relatives of individuals with
ADHD. The heritability of ADHD is substantial. While specific genes have been correlated with ADHD,
they are neither necessary nor sufficient causal factors.
Visual and hearing impairments, metabolic abnormalities, sleep disorders, nutritional de-
ficiencies, and epilepsy should be considered as possible influences on ADHD symptoms.

Course modifiers. Family interaction patterns in early childhood are unlikely to cause
ADHD but may influence its course or contribute to secondary development of conduct problems.

Causes of ADHD
The exact cause of ADHD is unknown. The most likely cause is genetics. Many children with ADHD
have a family history of the disorder.

Signs & symptoms

Based on DSM-V-TR criteria for ADHD
A. Either (1) or (2)
(1) Six (or more) of the following symptoms of inattention have persisted
for at least 6 months to a degree that is maladaptive and inconsistent with
developmental level:

Inattention
(a) Often fails to give close attention to details or makes careless mistakes
in schoolwork, work, or other activities.
(b) Often has difficulty sustaining attention in tasks or play activities.
(c) Often does not seem to listen when spoken to directly.
(d) Often does not follow through on instructions and fails to fi nish schoolwork,
chores, or duties in the workplace (not due to oppositional behavior or
failure to understand instructions).
(e) Often has diffi culty organizing tasks and activities.
(f ) Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or homework).
(g) Often loses things necessary for tasks or activities (e.g., toys, school
assignments, pencils, books, or tools).
(h) Is often easily distracted by extraneous stimuli.
(i) Is often forgetful in daily activities.

(2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6
months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity
(a) Often fidgets with hands or feet or squirms in seat.
(b) Often leaves seat in classroom or in other situations in which remaining
seated is expected
(c) Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness).
(d) Often has diffi culty playing or engaging in leisure activities quietly.
(e) Is often “on the go” or often acts as if “driven by a motor.”
(f ) Often talks excessively.
Impulsivity
(g) Often blurts out answers before questions have been completed.
(h) Often has diffi culty awaiting turn.
(i) Often interrupts or intrudes on others (e.g., butts into conversations
or games).

B. Some hyperactive-impulsive or inattentive symptoms that caused

impairment were present before 7 years.

C. Some impairment from symptoms is present in two or more settings

(e.g., at school [or work] and at home).

D. There must be clear evidence of clinically signifi cant impairment in social,

academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a

pervasive developmental disorder, schizophrenia, or other psychotic
disorder, and are not better accounted for by another mental disorder
(e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality
disorder).

Types/ classification :

There are three different types of ADHD, depending on which types of symptoms are strongest in the
individual:

● Predominantly Inattentive Presentation:

It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions
or conversations. The person is easily distracted or forgets details of daily routines.

● Predominantly Hyperactive-Impulsive Presentation:

The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework).
Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with
impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at
inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with
impulsiveness may have more accidents and injuries than others.

● Combined Presentation:
Symptoms of the above two types are equally present in the person.

Specify current severity:

Mlild: Few, if any, symptoms in excess of those required to make the diagnosis arepresent, and symptoms
result in no more than minor impairments in social or occupational functioning.

Moderate: Symptoms or functional impairment between “mild” and “severe” are present.

Severe: Many symptoms in excess of tliose required to make diagnosis, or several

symptoms that are particularly severe, are present, or the symptoms result in marked
impairment in social or occupational functioning.

Nature of ADHD:
Barkley (1997) noted a number of behaviors associated with ADHD that cannot be explained by poor
attention:
• poor persistence of effort;
• poor compliance to parental and teacher commands;
• diminished delay of gratification;
• reduced tolerance for delay periods;
• excessive activity;
• greater variability of behavior and work;
• hyper-responsive to environmental events;
• delayed internalization of speech;
• poor working memory;
• delayed motor coordination and motor control;
• deficient verbal fluency;
• diminished sensitivity to reinforcement and punishment;
• poor emotional self-regulation.